Erasing stigmas through storytelling: why interactive storytelling environments could reduce health-related stigmas

Figures & data

Figure 1. We propose to design interactive storytelling environment that shape the conceptual storytelling space of stigma actors to motivate them to 1) appropriate, 2) reflect on, and 3) co-create their stories.

Figure 2. The health-related stigma perpetuation model – a vicious circle (with obesity-related examples).

Figure 3. People with chronic illnesses can experience interrelated vicious circles of health-related stigma on three levels. Examples of human and non-human actors are visible on the right.

Figure 4. Three mechanisms to break the vicious circle in the health-related stigma perpetuation model. 1) Diminish stigma manifestations (press machine). 2) Deconstruct motivations (chisel and hammer). 3) deal with stigmatization (scissors).

Table 1. Seven potential functions of story content and story interactions in three basic stigma-reducing mechanisms.

Stigma-reducing mechanisms	Potential functions of story content	Potential functions of story interactions
Diminish manifestations	1) Expose victims and perpetrators to other perspectives	2) Provide a protective frame and 3) intervene in daily conversations
Deconstruct motivations	4) Reach stigma actors with persuasive messages	5) Exchange alternative understandings
Deal with stigmatization	6) Elicit understanding and support for stigma victims	7) Support stigma coping by stigma victims

Figure 5. Seven functions of interactive storytelling environments intervening on three mechanisms in the self-perpetuation of stigma.

Figure 6. The game of Ball & Stick: a physical board game with mobile application.

Table

Introduction story
This is the story of Ball and Stick. It is a fantasy story, but the events come from true stories that people experienced in real life. Ball has overweight and Stick does not. Ball and Stick experience their weight in their own way. They also talk and think differently about balls and sticks. And about weight. People with overweight are regularly discriminated against. This causes stress. And stress is unhealthy. It increases the problem of being overweight. The goal of this game is to increase your knowledge about discrimination on weight. And how you can reduce it. In this game, Ball and Stick experience many different situations. You have to answer a question in each situation. There are no right or wrong answers and there will be no winner. The game finishes when you’ve reached the end together. But how do you do this? You play the game with two players. Both of you have a role; one can choose Ball and the other Stick. If you’re with three, then one player can choose which role to join. If you’re with four players or more, you can play in teams: team Ball and team Stick. Make a paper pawn of Ball and Stick. Place Ball and Stick on position one. Ball begins. Press “Start”.
Dilemmas
Ball steps onto a crowded bus. There is only one narrow seat left. What do you do? Take a seat and be sandwiched with other passengers. Keep standing with pain in your back.
Stick steps onto a full bus. There is only one seat left next to someone who takes a lot of space. What do you do? Sit against him or her. Keep standing.
Ball is standing in front of an elevator and hears others thinking: “such balls should take the stairs”. What do you do? Don’t care about what others are thinking Explain that you have a knee injury.
Stick is stepping into an elevator. Stick sees someone approaching who is clearly overweight. What do you think? “It would be better if that person would take the stairs.” “There’s someone coming, I’ll keep the door open.”
Ball is at work. Someone is serving cake. Ball is being skipped and doesn’t like this. What do you do? Ask for a small piece Nothing, because you feel ashamed.
Stick is at work. It’s Stick’s birthday, so Stick is serving cake. What do you do? Not tempt the colleague with overweight and serve an alternative treat. Ask if the colleague with overweight would like a piece of cake.
Ball is at the supermarket. Chips and soda are on discount, so Ball buys chips and soda. In the cue at the cash desk someone looks disapprovingly at the groceries. What do you say? “This is not for me.” “Mind your own business”.
Stick walks through the supermarket. Stick sees a person that is overweight buying chips and soda. What do you think? “That person buys very unhealthy stuff!” “Nice! That person is throwing a party.”
Ball is alone at home and looks in the mirror. What do you think? “I need to put on beautiful clothes, so I will look thinner.” “I look good.”
Stick is alone at home and looks in the mirror. Stick has gained some weight. What do you think? “I will lose weight naturally, I don’t need to do anything about it.” “It’s time to go to the gym again, then I’ll lose those kilos in no time.”
Ball is at a party and sees Stick. What do you think? “Such a skinny and cheerless person.” “Nice to meet someone different.”
Stick is at a party and sees Ball standing next to the snacks. What do you think? “Nice party.” “Always the same people standing close to the snacks.”
Ball is at a party talking with some other balls. Ball sees Stick looking at Ball. What do you think? “Stick probably thinks I am ugly, I will not approach Stick.” “Stick likes me, I will go sit next to Stick.”
Stick is at a party sitting on the couch. Ball is attracting Stick’s attention. What do you think? “Ball is not like me. That’s not going to work out.” “Ball is different. I would like to get to know Ball.”
Open response task
Ball and Ball’s partner are walking through the park. They see Stick walking. “All those skinny smart asses, yet they look very unhealthy”, says Ball’s partner. How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Stick and Stick’s partner are walking in the park. They see Ball walking. Stick’s partner is pointing at Ball. “Those balls always look very unhealthy.” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Ball is at the doctor for pain in the knee. The doctor says: “Go first lose some weight.” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Stick is at the doctor for a sore knee. The doctor says: “There’s nothing you can do about it. Here’s a prescription for painkillers”. How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Ball and the partner of Ball are running on a treadmill at the gym. Ball is exhausted and stops. Ball’s partner says: “Just continue, lazy ass!”. How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Stick and Stick’s partner are at the gym. They see Ball doing exercises. Stick’s partner says: “I bet that ball will drop out any minute now”. How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Ball is standing next to a plus-size rack in a clothing shop. Ball thinks: “Why is the plus-size clothing on a rack separate from the other sizes?” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Stick is standing in a clothing store. Stick sees a rack of plus-size pants. Stick thinks: “Why can’t those balls just lose some weight?” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
The partner of Ball is coming home from work. Ball’s partner says: “Finding a job is a lot easier for Sticks than for us.” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Stick and Stick’s partner are at a library. Stick’s partner says: “Balls are stupid, they think that paprika crisps are healthy.” How would you react to this? Form your opinion and tell it in 20 seconds to the other.
Ball is at a party. Ball sees Stick sitting on the couch. Ball joins Stick and thinks: “With Stick I do dare to talk about my weight.”
Stick is at a party. Stick sees Ball sitting on the couch. Stick joins Ball and thinks: “With Ball I can have conversations that are not only about how I look.”
Making choices together
Ball and Stick want to do sports together in the park. How do you do this? Choose a way of doing sports without saying it to the other: Stick runs too fast, so they go separate from each other. They walk slowly, so Ball can keep up. Stick goes running and Ball cycles along. Did you both choose for the same option? If not, choose again for a shared answer.
Ball and Stick prepared dinner together. They want to add a drink that tastes good and is healthy. Which drink will you choose? Choose a drink without saying it to the other: Water. Alcohol-free beer. Fresh orange juice. Did you both choose for the same option? If not, choose again for a shared answer.
Stick and Ball organize a party. With balls and sticks mingled together. One of the balls greets Ball: “Hi chubby! How are you?” How would you call someone with overweight? Choose for a word without saying it to the other. Fat. Someone with obesity. Think of another word. Did you both choose for the same option? If not, choose again for a shared answer.
Ball and Stick are invited for a wedding with a lot of food. They are not sure if they should go. Why do you hesitate? Choose a reason without saying it to the other: Because they are afraid to get nasty comments. Because they don’t want to eat too much. Because the seats might be too narrow. Did you both choose for the same option? If not, choose again for a shared answer.
Ball and Stick go on a trip by bus to Zeeland. One seat costs 10 euro. What do you do? Choose what you would do without saying it to the other: Book an extra seat. Sit tight. Stay home. Did you both choose for the same option? If not, choose again for a shared answer.
Ball and Stick are sitting on the couch at home. Ball says: “I love you Stick”. “I love you too”, says Stick. How do you think about love? Choose a sentence without saying it to the other: Love is cooking delicious meals for each other. Love is letting the other win in a game. think of a sentence yourself. Did you both choose for the same option? If not, choose again for a shared answer.
Ending story
Congratulations! You’ve reached the end! The story started with Ball and Stick stepping into a bus. Did you choose to sit? Or rather not? Ball and Stick sometimes did see each other, but they didn’t talk to each other. Then Ball and Stick meet each other at a party. They mainly notice each other’s differences. Among the other Balls and Sticks they encounter many false beliefs. They point at each other and judge each other. But Ball and Stick start to realize that the differences are not so large at all. Being fatter or slimmer is just the way it is. By talking to each other Ball and Stick understand each other better. They also understand other balls and sticks better now. Were you able to better understand Ball and Stick? Did you notice that you also judge people with overweight sometimes? Maybe without being conscious about it? And do people with overweight know that others often have good intentions? We hope that, after playing this game, you can now better deal with differences in weight without making others feel bad about it. Just like Ball and Stick!